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General NPI Number Information
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NPI Number | 1609211044
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Entity Type | Organization
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Legal Business Name | FLORIDA CENTER FOR BRAIN AND MIND, LLC
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Dates
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Enumeration Date | 04/29/2013
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Last Update Date | 04/30/2013
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Provider Practice Location Address
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Address Line | 134 N RIDGEWOOD DR STE 15
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City | SEBRING
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State | FL
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Zip | 33870-7200
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Country | US
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Telephone | 863-658-0151
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Fax | 772-202-6042
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Provider Business Mailing Address
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Address Line | 134 N RIDGEWOOD DR STE 15
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City | SEBRING
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State | FL
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Zip | 33870-7200
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Country | US
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Telephone | 863-658-0151
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Fax | 772-202-6042
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Authorized Official
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Title or Position | MANAGER
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Name | DR. JUDITH HORVATH
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Credential | PH.D.
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Telephone | 863-658-0151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY8325
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | PY8325
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License Number State | FL
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